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Currently, managed care is the most common health care delivery system in Medicaid. In 2007, nearly two-thirds of all Medicaid beneficiaries are enrolled in some form of managed care – mostly, traditional health maintenance organizations (HMO) and primary care case management (PCCM) arrangements.
[1] [2] Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. [3] Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. [4] Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries. [5]
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
Of the more than 4.5 million people who have gone through the Medicaid recertification process, 2.3 million have had their Medicaid renewed, but only 233,256 by using the ex parte process of cross ...
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The Texas Health and Human Services Commission is standing by its decision not to award a large Medicaid contract to Cook Children’s Health Plan, a major provider of Medicaid health insurance to ...
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
More than 700,000 Texas kids have lost their Medicaid health insurance this year. Some will go without any type of insurance. Texas becomes ‘ground zero’ for kids losing their Medicaid health ...
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